It’s natural enough for parents and even grandparents to worry about how much children are eating and whether they are growing properly. We look at our children and wonder what their full potential height is.

Children aged five to 13 years appear to grow rapidly, but the real growth spurts are in the first year of life and in puberty.

It can be frustrating when you’ve been carefully measuring out the proper serving suggestions for your toddler and you are met with total ambivalence. But it’s normal that children sometimes find other things more interesting than your best homemade meatballs.

Studies have found that, while toddlers’ appetites are more unpredictable from meal to meal, they are usually good at self-regulating how much they eat over the course of a day so that their calorie intake is pretty constant.

If they are picky at lunchtime, they probably will make up for the shortfall in calories with a bigger snack or dinner.

As snacks make a critical contribution to a young child’s calorie intake, there is an opportunity to make them count nutritionally too.

Instead of the less nutritious foods often associated with adult snacking and rewarding, a toddler’s snack needs to make up for the disinterest in the meatballs at lunch.

Nestling in a cafe with your cappuccino and scone after a stint with the buggy and kids may be well earned by you, but a standard-sized brownie or muffin is not the best snack for those who have been sitting in the buggy all afternoon.

Toddlers may have an innate sense of when they are full, but children learn to overeat too.

Poor appetite in a toddler is a concern if it lasts for several meals or if your child’s growth isn’t progressing normally.

Growth monitoring, usually carried out by a public health nurse, practice nurse or GP, is a vital part of a toddler’s health assessment and nutritional status.

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In the 1980s, Prof David Barker’s work on the foetal and infant origins of adult disease led to further research examining the effect of both slow and excessive weight gain in infancy.

Growth patterns

A baby’s growth pattern during the first year of life is strongly related to health and risk of disease in adulthood. A Helsinki study in 2001 of more than 4,600 men demonstrated that low weight gain during the first year of life was associated with an increased risk of coronary heart disease, independent of birth weight.

Babies who fail to thrive are shown to have a delayed progression to solid food, poorer appetites and to eat a narrower range of foods. Excessive weight gain in the first year of life is associated with insulin resistance, diabetes, hypertension and heart disease.

Monitoring growth reassures most parents that their child’s growth is on track. For others, it’s a good way of highlighting potentially helpful changes to feeding patterns.

Measurements such as length for age, weight for age, length for weight and head circumference provide essential information on the growth and nutritional status of children. A once-off single measurement is meaningless and serial measurements are necessary over time.

Breastfed babies gain more weight in the first six months of their first year, but there is a gradual decline in their second six months. A similar pattern is seen in their length. This is considered the ideal natural growth rate and one that should not deter or worry the breastfeeding mother. The new World Health Organisation UK growth charts used by health professionals can help reassure parents on a number of measurements.

In most children, height and weight follow consistently along a channel, between two centiles. Unexpected movements away from an established channel are worth reviewing. If a child’s growth falters, a health professional can examine the frequency and volumes of milk and water. Perhaps the concentration of the milk feed needs reviewing.

Babies should not be weaned before four months, and foods should be introduced as near the six-month mark as possible, and not after. If the reason for slow growth is not evident, it may be necessary to seek a referral to a paediatrician or paediatric dietitian.

The other largest growth spurt comes during puberty. Height is largely genetically determined and a child’s height will be similar to that of the parents, closer to the father for male children and closer to the mother if female.

Of course, getting the right nutrition, enough sleep and adequate exercise allows children to reach their maximum potential height. So they grow as tall as they were meant to grow.

Siblings who eat similar diets have different heights, partly because the mix of genes from their parents is different in each child.

The greatest effect of diet can be seen in malnourished children whose development and height are stunted.

While a healthy balanced diet and a disease-free childhood will probably lead to the maximum height possible, there is no evidence that enriching or fortifying the diet with any particular food will alter the height that your child was genetically programmed to reach.

More importantly, the Food Safety Authority of Ireland (FSAI) scientific recommendations for a National Infant Feeding Policy outlines the need to collate children’s information into a central monitoring system to allow effective and efficient surveillance of growth patterns of children around the country.

This would help identify where public health initiatives are especially needed.

Obesity

The idea that weight is a cosmetic concern is a notion of the past. Obesity is now recognised as a serious medical condition. However, parents who are overweight or obese themselves are less likely to perceive obesity in their child.

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The home environment is critical in shaping eating behaviours, and dietary and physical activity habits in children.

With more parents working outside the home, shopping and food preparation can be more challenging.

As children increasingly fend for themselves, educating them about food and the benefits of making healthy choices will need to become more of a priority for national health campaigns.

Information about healthy foods in itself is not adequate to bring about the change we need to see.

Paula Mee is a dietitian and member of the INDI. She works in Medfit Proactive Healthcare medfit.ie Tweet @paula_mee

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